Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101052809 | VA |
NPI | 1013028620 |
---|---|
Provider Name | Linda M. Serwatka |
First Address | Hampton, VA 23664-1751 |
Second Address | Newport News, VA 23606-4437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5901502 | (05) | VA |
G98491 | (02) | VA |